tbuckley/cabot-search huggingface dataset:
Abstract 13572: Feasibility and Preliminary Efficacy of a Novel YouTube Based Physical Activity Intervention in Adults With Overweight/Obesity
Authors: Jacob K Kariuki, Lora E Burke, Bethany Barone Gibbs, Kirk Erickson, Andrea Kriska, David Ogutu, Heather Milton, La’Vette Wagner, Neel Rao, Breanna Sundheim, Abigail Daley, Sabina Hirshfield, Susan M Sereika
Journal: Circulation (2022)

Background: Only 14% of adults with obesity attain the national recommended guidelines for physical activity (PA). Yet, there is a paucity of interventions designed to address individuals’ barriers to PA. We designed a web-based Physical Activity for The Heart (PATH) intervention to address this gap. Purpose: To test the feasibility and preliminary efficacy of PATH in promoting PA and reducing cardiovascular disease (CVD) risk in adults with overweight/obesity. Methods: In a randomized controlled trial (RCT) with 12-week follow-up, participants were randomized to PATH (n=41) or wait-list control (n=41) groups. The PATH group received access to the PATH website and met twice/month with a remote coach. The control group received a self-help PA guide and twice/month newsletters on general health. Moderate-to-vigorous intensity PA (MVPA) was assessed via waist-worn Actigraph GT3X, steps via Fitbit Charge 2™, weight via smart scale, blood pressure (BP) via Omron BP machine, and lipids and HbA1C via dry blood spot. Generalized linear mixed modeling was applied to examine between- and within-group differences in PA, adherence to PA, and CVD risk factors. Results: The sample (N=82) was on average 55.9 ±8.2 years old; 57.3% white; 80.5% female; 79% obese (BMI 35.5 ±6.2 kg/m 2 ;) and 62.2% had ≥4yr of college. Recruitment lasted 6 months, and retention was 96.3%. Nearly all intervention participants accessed the PATH website ≥twice/week (92.1%), spent ≥10 min/visit (89.5%), and reported that the site was very appealing (68.4%), navigable (97.4%) and culturally appropriate (79%). At 12 weeks, the PATH group had greater mean changes in weekly MVPA (+59.2 min vs. +1.1 min, p=.024) and daily steps (+1,243.9 steps vs. -61.1 steps, p=.002) compared to the control group. While no between-group differences were detected for meeting the national PA guidelines or CVD risk factors over time, the PATH group showed modest but significant improvements in weight, BMI, body fat, waist circumference, and systolic BP (all p&lt;.05). Conclusion: This pilot RCT demonstrated that the PATH intervention is feasible and acceptable and provided preliminary efficacy in promoting PA among adults with overweight/obesity. Work is in progress to test the PATH intervention in a larger scale RCT.
Abstract 14028: Predictors of Atrial Fibrillation Free Survival in Patients With Implantable Cardiac Devices
Authors: Phu Mai, Michael H Kim, Attila Roka
Journal: Circulation (2022)

Introduction: Improvement of atrial fibrillation (AF) burden can be occasionally observed after pacemaker (PM) implant in patients with tachy-brady syndrome. On the other hand, patients may develop AF after the implant, even without prior history. We studied whether pre-implant parameters affect the risk of death or AF after device implant. Methods Data from 200 consecutive patients who underwent Medtronic dual (DDD) or triple chamber/cardiac resynchronization therapy (CRT) PM or ICD implants were analyzed. Pre-implant data included demographics, vitals, medications, comorbidities, labs, EKG, characteristics of any prior AF, echocardiographic parameters, and planned device type. Follow-up duration was planned as 12 months; survival and AF data (episodes &gt;5 minutes) were collected from device follow-up data. Survival analysis was performed for death and first AF occurrence. Results Average age was 75±10 years, 37% were female. Comorbidities included history of AF (26% paroxysmal, 13.5% persistent), coronary artery disease 48.5%, hypertension 83.5%, diabetes 37.5%, sleep apnea 26%, drug or alcohol abuse 12.5%, heart failure 43%, prior cerebrovascular event 9.5%. PM was implanted in 70%, ICD in 30% of patients; DDD devices in 83.5%, CRT in 16.5%.Follow-up duration was 338±111 days, mortality was 13%, 38.5% of patients had new onset or recurrent AF. There was no difference in mortality between the PM vs. ICD group (11.4% vs. 16.7%, p=0.597) and the DDD vs. CRT group (12.6% vs. 15.2%, p=0.781). The cumulative AF incidence was higher in the PM vs. ICD group (46.7% vs. 21.7%, p=0.037) and in the DDD vs. CRT group (41.9% vs. 21.2%, p=0.039). Conclusion: The type of implanted device, guided by pre-implant clinical parameters affects post-implant AF occurrence. Although ICDs and CRT are utilized in sicker patients, these groups had better AF outcomes - beneficial effects of cardiac resynchronization and routine use of goal-directed medical therapy in these patients prior to and after the implant may play a role.
Abstract 13882: Impact of Dementia on Inpatient Outcomes and Readmission Risks After Transcatheter Aortic Valve Replacement
Authors: Dae Yong Park, Muhammad Khawar Sana, Sami Shoura, Hasan Hammo, Jiun-Ruey Hu, Angela Lowenstern, Yousif Ahmad, Michael Nanna
Journal: Circulation (2022)

Introduction: The prevalence of both aortic stenosis (AS) and dementia increases with age, but studies evaluating in-hospital outcomes and readmission risk after transcatheter aortic valve replacement (TAVR) in patients with dementia are scarce. Hypothesis: The presence of dementia is associated with higher rates of adverse in-hospital outcomes and readmissions following TAVR. Methods: Using the National Readmissions Database 2017-2018, we identified all admissions for TAVR in patients with AS and stratified them to those with and without dementia. We assessed delirium and falls in hospital using multivariable logistic regression, and 90-day readmissions using multivariable Cox proportional-hazard modeling, adjusted for demographics, comorbidities, hospital characteristics, primary payer, median income, and elective admission status. Results: Among 48,923 TAVR procedures, 2,192 (4.5%) were performed in patients with dementia. Patients with dementia experienced higher odds of delirium (adjusted odds ratio [aOR] 4.50, 95% confidence interval [CI] 3.35-6.05, p&lt;0.01) and fall in hospital (aOR 2.34, 95% CI 1.39-3.95, p&lt;0.01) during hospitalization for TAVR. Patients with dementia also experienced an increased hazard of 90-day readmission (adjusted hazard ratio 1.14, 95% CI 1.04-1.25, p&lt;0.01) (Figure 1). Causes of 90-day readmission were mostly non-cardiovascular. Conclusions: Patients with dementia undergoing TAVR suffered from increased odds of delirium and falls, with a higher hazard of 90-day readmission after discharge. These findings should be integrated into shared decision-making before elective TAVR.
Abstract 13672: Quality of Life Impact of Transcatheter Edge to Edge Repair of Mitral Valve With the Mitraclip System in Patients With Mitral Regurgitation and Cardiogenic Shock
Authors: Mina M Kerolos, Caleb Chiang, Joseph Eid, Ethan Ritz, Laith A Derbas, tisha M suboc, Fareed M Collado, Clifford J Kavinsky, Hussam Suradi
Journal: Circulation (2022)

Introduction: Transcatheter Edge to Edge Repair (TEER) of the mitral valve is a viable option for patients with moderate to severe mitral regurgitation (MR) who are at high surgical risk. TEER has been shown to improve quality of life (QOL) in patients with MR. Data is limited regarding QOL in patients with MR and cardiogenic shock (CS) who undergo TEER. Methods: A single-center, retrospective cohort study including adult patients with moderate to severe MR and CS who underwent TEER between January 2012 and December 2021. CS was defined as a sustained systolic blood pressure &lt;90mmHg for at least 1 hour, use of inotropes, vasopressors, or mechanical circulatory support, and clinical and lab findings of end-organ damage. The primary outcome was change in disease-specific health status (Kansas City Cardiomyopathy Questionnaire-Overall Summary score [KCCQ-OS] at 30 days. Statistical analysis was done using Wilcoxon signed-rank test and t-test. Results: Thirty-three patients with mod-severe MR and CS had undergone TEER (See table 1 for baseline characteristics) . KCCQ data were available on 30% survivors at 30 days. KCCQ increased from 17.19 (11.88) before TEER to 53.85 (30.89) in 30 days (mean change 36.67; 95% CI 14.24-59.09; P&lt;0.05, see table2). There was an improvement in 2 out of 4 KCCQ domains; symptoms frequency (mean change 49.17; 95% CI 18.17-80.16; P&lt;0.05) and social limitation (mean change 49.54; 95% CI 22.25-76.83); P&lt;0.05). Conclusion: TEER of the mitral valve improves QOL at 30 days in patients with moderate to severe MR and CS.
Abstract 13351: Firefighter Coronary Atherosclerotic Burden Compared to Non-Firefighters
Authors: Luay Alalawi, Venkat S Manubolu, Dhiran Verghese, Jairo Aldana-Bitar, April Kinninger, Ahmed K Ghanem, Khadije Ahmad, Ahmed Shafter, Zahra Al-Chokhachi, Ilana Golub, Amit Johanis, Sion Roy, Matthew Budoff
Journal: Circulation (2022)

Introduction: Cardiovascular (CV) disease is the leading cause of death for on-duty firefighters. According to the National Fire Protection Association (NFPA), 44% of all fatalities were due to sudden cardiac deaths, and 90% of which were due to coronary artery disease. Furthermore, firefighters are prone to occupational behaviors, conditions, and environmental exposures that may increase their adverse outcomes. In this study, we will attempt to explore the atherosclerotic differences between firefighters and non-firefighter individuals. Methods: 302 firefighters from the Los Angeles fire department who underwent coronary computed tomography angiogram from 2008 to 2021 were matched 1:1 for age, gender, race, diabetes mellitus (DM), hyperlipidemia (HLD), hypertension (HTN), and past smoking to a control cohort for comparison of semi-quantitative coronary plaque burden. Each coronary segment was assessed by a semi-quantify plaque severity (0 for no plaque, 1 for minimal or mild, 2 for moderate, 3 for severe) and luminal stenosis (0: none, 1: &lt;30%, 2: 30-49%, 3: 50-69%, 4: 70-99% and 5:100%). The total plaque severity score (TPS) was calculated by the sum of the individual segment plaque severity score. The total segment stenosis score (TSS) was calculated by adding all the individual segment stenosis score (SSS). Segment involvement score (SIS) was calculated by summing the total number of coronary segments with plaque. Results: Mean (SD) age was 51.3 (6.6); 2% were diabetic; 34% had hyperlipidemia; 19% were hypertensive; 10% were prior smokers in each cohort. The Fire Fighter cohort had significantly higher coronary calcium scores (mean 42.5 vs 12); p&lt;0.0001, TPS at 3 (IQR (1,6) vs 2 (IQR (0,5)); p&lt;0.0001, TSS 3 (IQR (1,5) vs 2 (IQR (0,5)); p&lt;0.0001 , and SIS 2 (IQR (1,4) vs 2 (IQR (0,4)); p&lt;0.0001. Conclusions: After matching for age, gender, race, DM, HTN, HLD, and past smoking. Firefighters had more plaque burden, more stenosis, and more diffuse disease when compared to nonfirefighters, illustrating the occupational effects on the atherosclerotic process
Abstract 14134: Associations of Social Determinants of Health With Pulmonary Hypertension Severity and Reported Quality of Life
Authors: Benjamin Aronson, Cat Humpal, Rebekah H Anguiano, Dustin R Fraidenburg
Journal: Circulation (2022)

Introduction: Though the chronic, progressive disease Pulmonary Hypertension (PH) has no known cure, timely and appropriate treatment can improve outcomes. Social determinants of health (SDH) may influence treatment accessibility and outcomes. We hypothesized that Social Vulnerability Index (SVI) and Hardship Index (HDX, i.e., living in a zip code of higher hardship) are associated with measures of PH severity and quality of life (QoL). Methods: Patients at UI Health aged ≥18 years, diagnosed with PH from 2017-2021, and with EmPHasis-10 QoL scores and residence zip code data were included. SDH included Social Vulnerability Index (SVI) and Hardship Index (HDX). Income was retrieved from 2019 US Census data and most recent socio-behavioral data from the Chicago Health Atlas. Multivariate and logistic regression analysis were performed using SAS. Results: In 58 patients, mean age was 58 (SD 13.5), 47 (81.0%) were women, and 42 (72.4%) were non-Hispanic black. In this cohort, the uninsured rate showed a significant positive correlation with tricuspid regurgitant velocity on echocardiogram (p = 0.048) and, as SVI increased, there was a trend toward higher right atrial pressure (p = 0.07). Unexpectedly, there was a trend toward lower EmPHasis 10 scores (indicating better reported QoL) in subjects with worse SVI or HDX. When examining this further, a modified EmPHasis 10 QoL score focused on rest, exhaustion, and energy showed a significant inverse correlation of QoL with either SVI or HDX (p = .025 and p = .045, respectively). Conclusions: SDH appear to be associated with measures of PH severity. These findings suggest that SDH may negatively impact disease, which will need to be tested in a longitudinal study. The inverse correlation of SVI and HDX with QoL, particularly when focusing on personal experience, was unexpected. In theory, perceived norms and cultural context in high hardship, socially vulnerable communities may alter patient perception of disease impact on QoL. Future analysis should focus on further characterization of patient experiences in diverse populations with PH to ensure that we have accurate tools and are addressing the needs of our diverse community.
Abstract 14243: Machine Learning-Based Prediction for Functional Recovery After Coronary Artery Bypass Grafting
Authors: Koichi Inoue, Hirotada Masuda, Daisuke Yoshioka, Tetsuya Saito, Takuji Kawamura, Shigeru Miyagawa
Journal: Circulation (2022)

Background: Patients with improved left ventricular ejection fraction (LVEF) after coronary artery bypass grafting (CABG) are known to have a better prognosis. In patients whose LVEF does not improved, the next alternative is cardiac regenerative therapy. However, surgeons cannot establish an appropriate surgical strategy because it is unpredictable what improvement will be achieved for the patient before CABG. Recently, it has been reported that high-quality medical data and machine learning (ML) can be used to predict diseases.Hypothesis:A ML model with preoperative values of patients could predict functional recovery of LVEF after CABG.Patients and Methods:Three hundred forty-two patients with reduced LVEF who underwent isolated CABG in Osaka University Medical Hospital were included. Reduced LVEF was defined as less than 50% by preoperative echocardiography. Functional recovery of LVEF was defined as the condition with a 5% improvement of LVEF after CABG. Seventy percent of the patients’ data was used as a training dataset, and the other 30 percent was used as a test dataset for ML. Eighty preoperative features, such as creatinine level, were used for ML model construction.Results:Two hundred fifteen patients got functional recovery after CABG. Our unique ML model found five important preoperative features; histories of hypertension, chronic obstructive pulmonary disease, diabetes mellitus, cerebrovascular disease, and hemodialysis. The trained Extra Trees Classification model with these five features could predict the patients’ functional recovery with 70.7% accuracy in the test data. The predictive model had the area under the curve was 60.9 in the receiver operating characteristic curve.Conclusion:Machine learning-based prediction could work to sort patients with ischemic heart disease into recovery or non-recovery groups after CABG. This algorism may contribute to future precision medicine.
Abstract 14320: Regionalization of Non-Pulmonary Vein Triggers for Atrial Fibrillation Using Non-Invasive Electrocardiographic Imaging
Authors: Munveer Thind, Martin Arceluz, Qing Lou, Sara Ciaverelli, Irene Lucena Padros, Maciej Kubala, Bishnu P Dhakal, Weeranun D Bode, Maxime Cerantola, Maiwand Mirwais, Kelvin Bush, Erica S Zado, Gustavo Guandalini, Matthew C Hyman, David Lin, Rajat Deo, Saman Nazarian, Cory M Tschabrunn, Robert D Schaller, Andrew E Epstein, Gregory E Supple, David S Frankel, Pasquale Santangeli, David J Callans, Francis E Marchlinski
Journal: Circulation (2022)

Introduction Ablation of non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation (PVI) reduces atrial fibrillation (AF) recurrence, but localizing NPVTs can be challenging. We evaluated the potential for noninvasive electrocardiographic imaging (ECGi) to regionalize NPVTs and expedite more focused catheter-based mapping. ECGi combines measured body surface potentials with heart-torso geometry acquired from computed tomography (CT), to generate an activation map from a single recorded beat. Methods In 12 patients with AF undergoing first time AF ablation, the ECGi vest was fitted for preprocedural CT scan and then worn during procedure. Following completion of PVI, we paced from 15 atrial sites where NPVTs commonly arise (Figure 1), and evaluated the epicardial activation map generated by ECGi during steady state pacing at cycle length of 700-800 ms allowing an unobscured P wave. Merging of invasive anatomic map with CT-based ECGi map allowed comparison of ECGi activation map with true pacing location (Figure 2). Results From 180 pacing sites in our patient cohort (67% male, 58% persistent AF, 67% left atrial dilation), median distance between earliest activation site on ECGi map and pacing location was 16 mm (interquartile range, 11-22 mm), with 95% of sites within 30 mm (Figure 2). Septal pacing sites were measured to the epicardial aspect of the interatrial septum. Conclusions ECGi is able to consistently approximate the origin of paced beats from common NPVT sites and suggests the potential for rapid regionalization of NPVTs. The identified region can then be the focus of more detailed catheter-based mapping techniques to facilitate successful ablation of NPVTs.
Abstract 14224: Patient Differences in Prescription Patterns for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors When More Intensive Therapy is Needed
Authors: Mark B Effron, Anjali Kakkar, Greg Desrosiers, Cruz Velasco-Gonzalez, Rhonda M Cooper-dehoff
Journal: Circulation (2022)

Introduction: Statins are the cornerstone therapy to lower low density lipoprotein cholesterol (LDL) but not all patients (pts) tolerate statins or reach LDL goal reduction with statin therapy. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) potently reduce LDL and demonstrate reduction of cardiovascular (CV) events compared to placebo. Despite this, prescribing rates of PCSK9i are low. Hypothesis: This study aims to identify patient factors associated with PCSK9i prescriptions. Methods: Pts with a prior CV event or diabetes with LDL &gt;70 mg/dL on maximally tolerated statins or statin intolerant were identified using PCORnet clinical data marts (CDM) from REACHnet and OneFlorida. Pt demographics, co-morbidities, CV risk factors, 10-year ASCVD risk, and non-lipid lowering and lipid lowering drugs were provided in aggregate by the CDM. Categorical Baseline demographic and clinical characteristics differences were assessed by exact χ-square tests for categorical variables and Welsh t-tests for continuous variables. Unadjusted odds ratios (95% confidence intervals) were calculated to determine significance of the association. Results: Out of 464,664 pts, 0.3% received PCSK9i. Blacks had 21% lower odds of being prescribed PCSK9i as compared to whites. Non-Hispanics had 130% higher odds of being prescribed PCSK9i compared to Hispanics. Medicare pts had 44% higher odds of being prescribed PCSK9i than those with commercial insurance (Table). The presence of certain cardiac risk factors, such as MI and peripheral vascular disease, showed higher rates of PCSK9i prescription. Diabetes without known CV disease had the lowest odds of being prescribed PCSK9i. Conclusions: PCSK9i were rarely used. Higher CV risk appears to be a driver for use while it appears there is a bias in use based on race and ethnicity. Further analysis is needed to determine the interrelation of factors that limit prescription of PCSK9i and developing strategies to overcome them.
Abstract 13551: Non-Invasive Assessment of Systemic Microvascular Function in Patients With Severe Aortic Stenosis Pre- and Post- Transcatheter Aortic Valve Intervention
Authors: Jonathan A Mailey, Paul Brennan, Julie Moore, Min Jing, James McLaughlin, Andrew Nesbit, Tara Moore, Mark S Spence
Journal: Circulation (2022)

Background: Aortic stenosis (AS) is associated with pathophysiological changes in both left ventricular and coronary microvascular structure and function. The treatment of AS with transcatheter aortic valve replacement (TAVR) has been associated with improvements in invasive indices of coronary microvascular function. This study sought to address whether systemic microvascular dysfunction was present in patients with AS and if microvascular function was altered by treatment of aortic stenosis with TAVR. The conjunctival microcirculation was used as the site for the non-invasive assessment of systemic microvascular function. Methods: Patients undergoing TAVR for the treatment of severe AS were compared to a cohort of age- and sex-matched controls without valvular heart disease. Conjunctival vascular imaging was performed in all subjects using a previously validated combination of a smartphone and slit-lamp biomicroscope. This technique allowed measurement of vessel diameter and other indices of microvascular function by tracking erythrocyte motion. Conjunctival hemodynamics were compared pre- and post-TAVR, in addition to between the severe AS and control cohorts. Results: A total of 165 patients were included (90 severe AS and 75 controls). Baseline characteristics were well matched between groups. In comparison to the control cohort, arteriole axial (Va) and cross-sectional velocity (Vcs) were significantly lower in females with AS (Va severe AS 0.53 ± 0.11mm/s vs control 0.59 ± 0.12mm/s, p=0.047; Vcs severe AS 0.38 ± 0.07mm/s vs control 0.41 ± 0.08mm/s, p=0.043), but not in males (Va severe AS 0.61 ± 0.11mm/s vs control 0.58 ± 0.10mm/s, p=0.19; Vcs severe AS 0.43 ± 0.08mm/s vs control 0.41 ± 0.07mm/s, p=0.20). Arteriole Va and Vcs significantly increased following TAVR in females (Va Pre-TAVR 0.52 ± 0.16mm/s vs post-TAVR 0.59 ± 0.15mm/s, p&lt;0.001; Vcs Pre-TAVR 0.37 ± 0.11mm/s vs post-TAVR 0.42 ± 0.11mm/s, p&lt;0.001). Conclusion: This study highlights sex-specific differences in conjunctival microvascular function in patients with severe AS. In this study TAVR resulted in significant improvements in conjunctival arteriolar V a and V cs . These findings are consistent with severe AS being a reversible cause of systemic microvascular dysfunction.